HomeMy WebLinkAboutSIEFKER #3 TR 5 LT 3
GR~'~.TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 :279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING ~,~,~. /~'~//'/~--Z_/,..,
ADDRESS PHONE.
LEGAL DESCRIPTION ~a,/
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
MATERIAL C~,'d ~,,"~:'y'~.,=~ NUMBER OF
COMPARTMENTS ~
z~ ~G/l/~ r /~'7~ LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
OUTSIDE DIAMETER
'
OR wIDTH r ,LENGTH , DEptH
LINING MATERIAL
NEAREST LOT LINE
DISTANCE FROM WELL -,~,~ r ,./_
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl.
NUMBER OF LINES
ABSORPTION AREA
, F?~LdF~ON /i~EST LOT LINE
TOTAL
LENGTH
STANCE BETWEE~ L NES ~/ /TRENCH WID,T'~I / /' IN. TOTAL EFFECTIVE
SQ. FT. LENGT~ EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
WELL: TYp5 ;~-;.bl~ / '~ ~/~'~l(--r I-~0u0~ e./) /'t~f?T~NCE FROM WATER
. ,BUILDING FOUNDATION. SAMPLE
NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL
IN. ABOVE TILE
., NEAREST
OTHER
, SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE
?
HEAL1H AUTHORITY
GA ~-IID-2
GREATE]r
327 Eagle St.
.kNCHORAGE AREA
HEALTIt DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279.2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~P4/t/
RESIDENCE ADDRE88_., ~.'~'~:") ~/' ~':'
LEGAL DESCRIPTION, L
APPLICATION TO INSTALL: SEPTIC TANK
MAILING ADDRESS ~.-)~;~ ~' (~:&'~)~';/PHONE NO._
LOCATION OF INSTALLATION..~~'2'~ ~)/2% ~",/::'f" ~M~I.~ '~
SEEPAGE PIT. ~/'- ,DRAIN FIELD.
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~) ~ ~J ~
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION.
BI:LOW TO BE FILLED OUT BY HEALTH DEPARTMENT
,OTHER,
TO BE INSTALLED BY. ~L)~E~d~
THIS IS TO SERVE AS t~'~/'~,. [.~_~-,~':)d~/0 ,PERMITTO INSTALLA
_AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED
., SEPTIC TANK SIZE ~'~'-'~'}}~ TYPE ( d4jh 6;4~ 2 SEEPAGE AREA
DISTANCES:
.,....,..,..,'-....'.'..'--/'
~-~,.,,'~ ~.~,~ ..... ~.~
/
TYPE
DIAGRAM OF SYSTEM //?//.~ d'~
I certify that I am familiar with the requkements of Greater Anchorage Area Borough qrdfl!ance No. 28-6~] and that the
above described system is i~ accordance with said code.
,. ~ ,.~. / ·
REATER ANCHORAGE AREA BOROUGH
ItEALTH DEPAkTMENT
327 EA~JJ, STREET
ANCHORAGE, ALAoKA 99501
CASE
Performed For Mar't~ m I,arsen Date Performed Apr~ ] 24~ 1970
· .~s,~,i'ot~on: Lot Block :-mb, c~v~s~on S.~efker
Legal De _z ~ ~, .
Depth
Fee~ Soil Chad',aeC;erisa[cs Location Sketch
Lt~ to Dk. brown
no s~nd in evidence
USCS Clas "t~L"
Sandy, Sf]ty Graven
Poorly graded Mss
USGS Class "OM-~"
Sandy Grave[[ "Skip~Grade
No slit ~n evidence -
Ft~x 3"
USCS Class "GP"
Was Ground Water Encountered?~_,n_~o,
if Yes, At What Depth
Reading
Date
Gross Time
Net 'rime
[.. oposed Instal~l~n?'Seepage Pit
Depth To H20
DlPain ~'
~ ].eld
Net Drop
Depth Of' Inlet
UulJaer ro oaes 2 to 3 'Feet ~ · ' '"
- ': ...... of aV
~ound,
Data Certified By: ~~ /